Single Anastomosis Duodeno-ileostomy (SADI-S) Versus One Anastomosis Gastric Bypass (OAGB-MGB) as Revisional Procedures for Patients with Weight Recidivism After Sleeve Gastrectomy: a Comparative Analysis of Efficacy and Outcomes

Abstract

Purpose Many revisional procedures are available for unsuccessful laparoscopic sleeve gastrectomy (LSG) in patients with complications or weight recidivism. Single anastomosis duodeno-ileal bypass (SADI-S) and one anastomosis gastric bypass (OAGB-MGB) are two revisional procedures to address the problem of weight recidivism. We aimed to evaluate the efficacy and outcomes of the 2 revisional approaches (SADI-S vs. OAGB-MGB). Materials and Methods A retrospective analysis of prospectively collected database of patients who underwent SADI-S or OAGB-MGB as a revisional procedure for weight recidivism after primary LSG with a minimum 1-year follow-up. Weight loss, comorbidities, nutritional deficiencies, complications, and outcomes were compared in the 2 procedures. Results Ninety-one patients were included in the study (42 SADI-S and 49 OAGB-MGB). There was a significant weight loss (total weight loss percentage, TWL%) at 1-year follow-up observed for SADI-S when compared to OAGB-MGB (23.7 ± 5.7 vs. 18.7 ± 8.5, p = 0.02). However, this difference was not statistically significant at 18 months (26.4 ± 7.3 vs. 21.2 ± 11.0, p = 0.25). Remission of comorbidities (diabetes mellitus and hypertension) was comparable. Although OAGB-MGB had higher complication rate than SADI-S, the difference was not statistically significant (p = 0.39). No mortality was reported in the study groups. Conclusion Both SADI-S and OAGB-MGB are effective and safe revisional procedures for weight regain after LSG. The shortterm outcomes are comparable; however, SADI-S is associated with less upper gastrointestinal complications and could be a better option for patients suffering from GERD post-LSG. Moreover, the underlying bile reflux may get worse with OAGB-MGB. However, further prospective larger studies are needed. Keywords Revisional surgery. Sleeve gastrectomy. Single anastomosis duodeno-ileostomy. One anastomosis gastric bypass Abbreviations BMI Body mass index LSG Laparoscopic sleeve gastrectomy SADI-S Single anastomosis duodeno-ileostomy OAGB-MGB One anastomosis gastric bypass/mini gastric bypass EWL% Excess weight loss percentage TWL% Total weight loss percentage GERD Gastroesophageal reflux disease T2D Type 2 diabetes mellitus A1C Glycated hemoglobin A1C Electronic supplementary material The online version of this article (

Single Anastomosis Duodenoileal Bypass or Roux-en-Y Gastric Bypass After Failed Sleeve Gastrectomy: Medium-Term Outcomes

“…Few studies have reported on weight loss outcomes of SADI-S as a secondary procedure. Reports on %TWL during the first 2 years after revisional SADI-S surgery vary from 20 to 26% TWL [18][19][20]. Three studies have demonstrated %TWL results measured from baseline weight at the time of SG and found 38-46% weight loss after SG and SADI-S during 1 to 5 years of follow-up [21][22][23].…”

Bile reflux after one anastomosis gastric bypass surgery: A review study

“…Finally, considering available data, bile reflux incidence after OAGB operation varies from 7.8 to 55.5%. This relatively wide span of postoperative bile reflux after OAGB may due to different reasons including sample size, subjects’ demographic characteristics, preoperative BMI, applying surgical technique, size of gastric pouch, diameter of anastomosis site, length of biliopancreatic limb, time of surgery, time of follow up and condition of other concurrent metabolic disorders at the time of surgery [ [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ]. Hence, it is highly recommended to design studies with greater sample size and more isolated consideration specifically for surgical technique characteristics to have more precise decision while bile reflux after OAGB is considered.…”

Minimally invasive gastrointestinal surgery: From past to the future

“…Many studies compared these techniques in terms of efficacy and outcomes. Bashah et al [ 47 ] reported both SADIS and OAGB-MBG were effective as revisional procedures with equivalent results in BMI loss, nutritional deficiency, and comorbidities’ remission. However, SADIS appears superior to cause fewer upper gastrointestinal complications.…”